Dr. Guy Maytal, MD on The Power of Diagnosis
On today's episode, psychiatrist Dr. Guy Maytal and I discuss what a diagnosis actually is and what it isn't, the importance of language, studying our history and being a humble physician.
Referenced in the Show
Weill Cornell Medical Center, New York Presbyterian Hospital
Simpson’s clip “We’ve tried nothing and we’re all out of ideas” (Season 8, Episode 8)
Dr. Maytal’s Bio
Guy Maytal, MD is currently an Assistant Professor of Psychiatry and serves as the Chief of Integrated Care and Psychiatric Oncology at Weill Cornell Medical College / New York-Presbyterian Hospital.
Dr. Maytal was educated at Harvard College and Johns Hopkins University School of Medicine. He completed residency in adult psychiatry at Massachusetts General Hospital and Fellowship in Psycho-oncology and Psychosomatic Medicine at the Dana Farber Cancer Institute – both in Boston, MA. He later served on the faculty of MGH and Harvard Medical School for 11 years, where he developed and expanded multiple clinical programs in the areas of general psychiatry, psycho-somatic medicine, and palliative medicine.
Dr. Maytal’s clinical work focuses on complex psychiatric patients and on the care of patients with life-limiting illnesses. He lectures and publishes on topics that include the care of complex patients, medical ethics, and physician-patient communication. He is committed that all people are free from the constraints of the past, creating their lives and living their creations
Full Transcript
Sarah Marshall ND: Welcome to HEAL. On today's episode, psychiatrist Dr. Guy Maytal and I discuss what a diagnosis actually is and what it isn't, the importance of language, studying our history and being a humble physician. I'm your host, Dr. Sarah Marshall.
Sarah Marshall ND: Guy Matyal, thank you for being here.
Guy Matyal MD: Pleasure, pleasure Sarah Marshall.
Sarah Marshall ND: This is, yeah, that you have been someone in my wanting to have be a part of this project since its inception. So this is like super, super, super exciting. And, I had some particular reasons why I've thought of you. And one is your experience working as a psychiatrist with cancer patients (Guy: yep) and also. You're one of those humans that I have don't think I've ever had a conversation with you over the eight plus years I've known you or six years, I've known you that I'm not left with. "Oh my God. I didn't know that. And that just altered something about the way I see my life and the world."
Guy Matyal MD: Thank you and yep. All of a sudden there's a high bar to reach in this conversation.
Sarah Marshall ND: You're welcome. (both laugh) And that may not happen at all.
Guy Matyal MD: Oh I know, I know. I know. I know. Yeah. Yeah. That's a great,
Sarah Marshall ND: Cool.
Guy Matyal MD: Yeah.
Sarah Marshall ND: So I just want to start straight up with like, for you (snaps) personal experience, professional experience, life view, what does it mean to heal?
Guy Matyal MD: I just have to, actually officially say, cause I do work for various organizations (Sarah: good) and that I need to say that my views are my own and don't represent anything related to the organization of Weill Cornell in New York Presbyterian hospital. So that's kind of the disclaimer statement that I need to make here. Cause what I do professionally is I work as a psychiatrist at those organizations for Weill Cornell medicine, which is a medical school in New York city and New York Presbyterian hospital. It's affiliated hospital. And, I work on integrated care and it's called psycho-oncology, which is, broadly speaking the, the care of the psychosocial aspects of what it is to go through cancer and to have a loved one deal with cancer.
and I also think about how do we integrate. Mental health perspectives and treatments into other aspects of the general medical world. And I also think from a systems perspective and an ethics perspective, how did all those intervenes interface with each other? So I do some medical ethics as well. That's a little bit about me professionally.
What does it mean to heal? Well, are you talking from the person who is a self-identified healer or the person who is looking for healing?
Sarah Marshall ND: As an organism that heals.
Guy Matyal MD: Well, I don't know. Well, we can look together. I haven't thought about it. I think, I think at the very first step, it requires a certain degree of curiosity about this other organism human being in front of you or with you. It also requires a certain, humility about what you can and cannot reasonably accomplish in the time with my skill set, and to make that pretty explicit, I think it is about really being in whatever way that whatever that's means in this particular relationship to be in relationship with this person. That could be for five minutes, it could be for five years. and, it really is about having people heals themselves. Like, I don't know if I've ever healed anybody. I think the dance that we've been in me and the people that I take care of and consult to treat like that, the relationship heals, like, cause both of us are requisite. Can't walk on one leg. You can hop, (sarah: mhm yep) but it really does require both.
And, it also requires, I think both people being part of the work is to be in, is to do the work, to engage in the same project. In my work, a lot of people come with lots of assumptions about what it is that happens when you go to see a psychiatrist. A lot of assumptions. It is remarkable. Almost all of them are wrong. (Sarah: yeah) some of them, have to do with whatever stigma people have about mental health and mental illness. Some of the, some of those assumptions have to do with whatever people pick up in popular culture. (Sarah: mmm) People are scared to come and see a psychiatrist. So for some folks, it is the pain that they're experiencing has to be pretty severe because the, I, as I tell people the idea of seeing me as far scarier than the reality. When they meet me, it's like, they're like, well, where's the rest? I'm like: "this is it" (both laugh)
We engage in a conversation out of which you may or may not see something new, I may or may not make some recommendations. You may or may not like them and then we may or may not engage in them further. And that's kind of, it it's like, one of the things psychiatrists, I think in particular have to bring is a certain, a particular humility within the field of medicine, because it's not viewed as one of the, action hero (Sarah: mmm) specialties.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Nothing wrong with the action hero specialties. We're not one of those,
Sarah Marshall ND: we're just not one of those,
Guy Matyal MD: We're not the ones that gets paratrooped in to deal with like a bleeding leg artery or something like that. Or, if someone is having a hard time breathing, I'm not the first doctor you want around, to manage someone's airways, like where they, how you breathe. And it's funny, there was a, and I had that experience. Like I was, this experience of doctors either really look forward to a really dread when you're on a plane. Remember planes?
Sarah Marshall ND: Oh yeah! That thing we used to be able to do?
Guy Matyal MD: Thing we used to be able to do! The plane, and they fly up in the air, like a giant metal Eagle.
Sarah Marshall ND: This is good. Cause my very first patient contact...
Guy Matyal MD: yes.
Sarah Marshall ND: As a newly minted naturopath, where the ink was still wet on my license was actually on an airplane.
Guy Matyal MD: Nice. (Sarah: mhm) Yeah. that, that, that moment in an airplane, by the way, I don't understand. I used to complain about flying. I can't imagine I will complain again because it's kind of like, Oh, you mean the thing where we used to fly, like a, like a, like a superhero through the air
Sarah Marshall ND: The miracle where I could like get in a plane and five hours later be in a completely different part of the country or even the world.
Guy Matyal MD: That's right. That's right. That's right. So, the, the, the PA comes on, the flight attendant comes on and they say, is there a doctor on the plane? And I'm like looking around hoping somebody else rings the call. (Sarah: laughs) And I happened to be wearing my Johns Hopkins medicine. T-shirt that's why I went to medical school and the stewardess to the flights and it comes up to me and she goes she looks at my t-shirt. She looks at me. She looks at my t-shirt, are you a doctor?
And she.. I kind of bashily say yes. She goes why didn't you bring the button? I said, I mumbled something. I said, how could I help? And they're like, we have someone who, who doesn't, I think some trouble has a lot of stomach pain and we're in them over the Atlantic on our way to Italy. And the only question that needs to be answered really is do we land in Ireland or not?
Like it's not a small deal.
Sarah Marshall ND: Right?
Guy Matyal MD: Cause if this person is so sick, right. And, this was really at the end of my training. It's like you mentioned, you're newly mental. This was when I was a senior. I was a chief resident. I was also at the peak of my confidence and, no, it
Sarah Marshall ND: 'cause it's all downhill from there?
Guy Matyal MD: It's all downhill, no it wasn't.
But, but they said, Oh, he's having a lot of abdominal problems and he's kind of in distress and we don't know what to do.
And they give me the bag of his medications. He's an older gentleman and he's got, some older gentlemen pills for blood pressure and cholesterol and depression. And, and I'm like, okay. And he, they say, and by the way, he doesn't speak English. I'm like, what does he speak? And they said, hoping, I speak Spanish, I speak Hebrew.
And then they're like Arabic. I was like, Oh, well. (Sarah: not that one) Not that one. And, I said, all right. And of course, as I'm about to go see them, another doctor pops in much older than me looking very, very anxious. Says, do you need any help? And I said, what type of doctor are you? And he said, I'm a psychiatrist. I said, no, I've got this.
And I go back and see him, and at that moment, so the apropos to your question it's really does have a point. I was walking to the back of the plane. And what was walking to the back of the plane was Doctor. Yep. Cause that's what this person saw coming towards him. He didn't care about my particular anxieties or level of confidence or anything. He's just like, Oh, doctor is coming. And I got that moment. It was one of the first times where I really got doctor as a distinct entity from me personally, which is an essential part of this particular ritual that I am involved in on a daily basis. And, I went and I saw him and some of the distance, he didn't look sick and his stomach wasn't firm and he was pulse was fine.
And he wasn't sweating. I'm like, all right. He goes, he'll be fine. And I had a thought, right. And the thought was, I said to him, cause I knew what would the answer would be, because she doesn't speak in English. But I looked at him and his wife and she's wearing a hijab and this older Arab couple from Egypt.
And, and he's, I said, when was the last time you moved your bowels? Just like that. And he goes, he had no, he didn't know what I said. Right. Yeah. So then I tapped my watch, shrugged, my shoulders and kind of said "caca" and they really got it. And each of them held up three fingers simultaneously. Yeah. And I was like, Oh, he's constipated. Get him some Cola. And he went right to bed and he felt so much better. Cause the doctor had been to see him. Yeah. there was some moment of distress.
Sarah Marshall ND: So, this is actually perfect. I know you were kind of like, I didn't answer your question except you did. and one of the things you mentioned is the importance of relationship (Guy: yeah) and honoring who we occur as show up as how people see us, because doctor is present. (Guy: yeah) And inside of medical ethics. I can imagine there's all sorts of conversations of like abusing that or being responsible for that.
Guy Matyal MD: Yeah.
Sarah Marshall ND: And there's also this like power of healing I can see where like, when I, as a naturopathic physician, I'm often the first or only doctor who's told this person that what they're dealing with could get better. (Guy: mhm) Because in conventional medicine, in inside of their ethics, speaking from what they see, the predictable prognosis is given the tools and training that they have (Guy: yeah) is distinct from the training and tools that I have (Guy: yep) and what I've seen clinically and what I know is possible.
And so, (Guy: yeah) often that's the case and there's all I've done is say two or three sentences (Guy: yep.) and this person's whole outlook. And then thus corresponding actions start to shift. (Guy: yeah. Yep.) And one of the things that I recall from a previous conversation you and I had that I really wanted to talk about is like also with the power of the distinction and the, in the beingness of doctor comes the power of one of the critical things that we do on a regular basis, which is diagnose people or offer a diagnosis. (Guy: yeah, yeah)
And that's another world of a lot of expectations and a lot of assumptions, (Guy: yep) most of which are wrong. (Guy: yep) What does a diagnosis mean? Like what is a diagnosis actually? (Guy: yep)
Guy Matyal MD: Yeah. Yes, that's a great question. so here's what a diagnosis is not, it's not a thing that's in reality. I ask people, if you ask the people that take care of people with cancer, and I take care of people with psychiatric illness, right. And I asked them, where, when did you have cancer? If you can ask just that question, it really begins to get at what I'm going to be pointing at. When did you have cancer? And it's when I first felt the lump, I knew something was wrong, right. Or when I started having this pain, I knew some that's when the cancer started, but that's not reality.
That's an after the fact conclusion. Because at some point down the line, they were given this diagnosis of cancer and then they go back. Aha. The symptoms started here in that moment, what they had was pain. (Sarah: mhm) Or they had discomfort or they had a lump or they had something, right. Some symptoms, some, some bleeding from somewhere. They don't. And I asked them, when did you, when did you have, when did you get cancer? And they kind of look at me funny. Now, I don't usually do this with do this with patients. This is more or less true for other oncologists.
Cause this is just kind of stupid to do with a patient, just to be clear. (Sarah: yeah) But unless the person is really interested in like the philosophy of diagnosis, but like you don't, the oncologist is like, Oh, well, they have the (inaudible) . That's when they got cancer, I'm like, no, Or they'll say when the first mutation happened in the particular gene that led to the cell overgrowth, that event,
Sarah Marshall ND: That's the naturopathic answer is like the little process that leads up to it. Yeah.
Guy Matyal MD: Absolutely. The oncologists say the same thing. That's when it's really started, we don't know exactly it was somewhere back then. I'm like, no, that's not when it started. That's when something happened, but cancer happens the moment the pathologist says cancer. It's like. When is there a goal in soccer, American, everyone else in the world calls futbol, like people like, Oh, when the ball goes in the net, I'm like, no, I couldn't go onto the field and kick a ball into the net. And there ain't no goal, or it could be like before or after the start of the game, or it could be after somebody gets fouled or like it was out of bounds. There's no goal. The ball went in the net all those times. It's only when the referee says goal. That's when you have that's when you have goal, like you have cancer when expert who is given a particular authority by common understanding, in this case the pathologist, says cancer and frankly, patients don't have cancer until their oncologist says you have cancer. You walk into that meeting. Maybe, I don't know. Hopefully not, maybe it's benign. I'm not sure what it is, but you walk out, cancer, totally different world. Yep. Nothing's actually physically changed in anything, but inside of a span of a few minutes of speaking your whole world, your whole future everything's altered. (Sarah: mhm)
And that gets set to the nature of diagnosis. Diagnosis is a linguistic entity. It only exists in speaking and language. And it serves a particular function it's, especially by the way around psychiatric diagnoses, people get so worked up about, I'll say a little bit more about that in a minute, just to finish from what I'm thinking, like a diagnosis has three functions fundamentally. One is: so people can be talking about the same collection of things they observe and measure and things like that. Right. We call that signs and symptoms, right? Things patients tell us they're experiencing and things that we can observe or measure. So what I call. Pneumonia in Tokyo and in Bangladesh and in London is all pneumonia.
So we can be talking about. And when I say to you as a, as a human, who is traveling in Paris, you have pneumonia and then you go home and you tell your doctor in Utah, I had pneumonia, everybody's talking about the same thing. That's the first step. The other thing is it therefore gives you a sense of what's likely to happen.
That's the prognosis part, like what's likely to happen. And the third is so you could do something to intervene or comfort, (Sarah: mhm) but it's not a real thing. It's not a real thing until we start to relate to it as a real thing. (Sarah: yeah) And if you want an example of this and this kind of gets me in trouble, but I don't care.
I'm not really in trouble. Kidding. The DSM. Which is the diagnostic and statistical manual of mental illness, mental diseases, right? It's just the collection of diagnoses of psychiatric diagnoses, which is an interesting document to begin with because it wasn't originally designed for site for diagnosis, by the way, it was originally designed for research purposes.
It became, it became that, which we use for diagnosis because of lots of historical reasons, but nobody ever designed it, this app, It keeps getting bigger. Are there more and more psychiatric illnesses? Like the human experience is not any different than it was 50 years ago. Right? So it's, you could say it keeps getting more precise or more fine or refined, which is fine as long as what it is.
It's but with mental illness in particular, we talk about people as their illness in a way that is almost nowhere else in the world of healthcare or healing. Nobody says I am my heart disease, or I am kidney failure. People say, I am depressed. (Sarah: yeah) My cousin's bipolar. She's really anxious. Aren't you really aren't you really anxious, you're really an anxious person.
Which is con, which is really very, very, very, very, very, complicated, but fundamentally what it does is box people in, because if you are a thing, like I am six foot tall and I am depressed, there's nothing I can do about being six feet tall. And there's nothing I could do about being depressed. That's that's what I am.
That's what I am. And I just got to live with it versus it's something that I have, but then there's a space between the I and what I has. And then I may be able to do something with that, which should has versus what do you do with that which you are? Nothing, you survive it, you get through it, and this little subtle, a little nuanced shift, but like, like I said, it's all diagnostic language is language.
Sarah Marshall ND: Yeah.
Guy Matyal MD: So I have, it's really important that when I say be humble, I'm like, yeah. like 500 years ago they were talking about my asthma's. Yep. They were talking about, humor's not that long ago. Like it's not that long ago. if, if your, you, you, the (inaudible) humor is out of balance with your choleric humor.
when you say you're sanguine, someone is sanguine that's because that's from the humorous theory of healing and it worked really well. This thing worked, it was around for literally like 1,500 years, probably longer. And it'd be like, Oh, they were so backwards. It it flipping worked for 1500 years. (Sarah: yeah) What have we got that's been around for 1500 years?
Sarah Marshall ND: And in naturopathic medicine, we still use aspects of it. We we've continued to allow for its evolution, but I mean, I actually study the four temperaments of sanguine, caloric, melancholic, and phlegmatic and how they cross over between propensity towards different types of disease expression. Dis-ease as in the body is not fully optimal in its most healthy state. And do you have a tendency towards cold and damp phegmatic, hot and dry caloric, and then can even get into lifestyle aspects of how to balance those things is like one of the cornerstones of some of the naturopathic medicine that I practice.
Guy Matyal MD: Yeah.
Sarah Marshall ND: Still works as a lens to like, and for me as a practitioner, (Guy: mm) diagnosis gives me access to seeing a certain set of circumstances a particular way. (Guy: yeah totally totally) And I've seen it on both sides of the coin where I've had, I referenced them as clients, but like, I think people in my practice I've had clients that (Guy: yeah) they've had a diagnosis. Like I have had a recent client where they predominantly had viewed what their body was dealing with through the lens of mental illness. And the diagnosis had been anxiety and depression to clinical depression, to bipolar type two. And there'd been a lot of focus on all of that.
And it wasn't until he saw his first integrative practitioner a few years ago that anybody even said thyroid disorder. (Guy: mmm) And then I've since looked at fibromyalgia or chronic fatigue as an overlap. And there's a lot of overlap in the symptoms of clinical depression and chronic fatigue syndrome. And their causal roots can be very distinct.
And so we don't really, we can't even necessarily for sure say he is, has this one thing or the other, but there's power in us even being able to start to talk about it. Like there's some fluidity here. We can look at the physical things. We can look at the mental, emotional things. That's opened it up for him because for him, when it was bipolar type two, it was, I am that.
I will always be that I'm ashamed of that. There's something wrong with me. There was like all of that conversation inside of it.
Guy Matyal MD: Yep.
Sarah Marshall ND: Equally I have another client that when she was officially diagnosed with an auto-immune disease, it was so liberating because there was something she could communicate to her community that she wasn't just grumpy and had a little soreness in her body and had this, like, you communicate something when you can say, I'm dealing with this emotional or physical disease.
The world around her started to interact with her, what you need, how can I support you? What can we do about this? And it opened something up that hadn't been there before the diagnosis had happened.
Guy Matyal MD: Yeah. Hmm. Hmm. It gave her a new language. There's a, it's, it actually saves lives, right.
It really does in a very, very real way. Once you can see the world newly, then there's something you can do about it, like you were saying.
Yeah. I mean, it's, it's interesting. And it also gives me a place to stand, to have profound empathy for people, right? The, the notion. of people being bad people, that's just how they are versus people dealing with serious medical condition that is treatable and interveneable. Yeah. You really can see that in certainly in psychiatry, no better example than around substance use disorders over the last, two, three, four decades.
You don't have to go and it's still around, right? Like, but like the moralization of addiction addiction as a moral disease.
Sarah Marshall ND: Yeah.
Guy Matyal MD: If you only, you were stronger, you'd be able to get past it versus no, this is a medical condition that can be addressed and treated.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And there's no stigma with that.
Sarah Marshall ND: And even what we're discovering in the genetics of someone who has a propensity to just be more sensitized to something that actually predominantly is a toxin. That could actually be a forward moving part of evolution to be more sensitive to toxins such that you're deterred from it. Like, I mean, there's, we decide what it means, but it's like, ADD and ADHD is another one that I often, this is mostly anecdotal and maybe there are people that can back this up with the research, but my experiences, there's certainly nothing wrong with someone who falls in the category of ADD.
They see the world in an amazing way that I don't see the world. They interact with their day in a way that I don't interact. My sister and I, and there are, there is just this creative zest for life juice about her. And while I can follow my checkboxes and my calendar in a particular way, and I can tick all of these things.
My sister's ability to walk into a blank room and masterfully turn it into this like Haven of magic and whimsy. And I'm certain that that's in part because of her brain literally just operates and fires differently than mine.
Guy Matyal MD: Yeah. I mean, this is where we're going to disagree in that I don't want to, on the one hand, there actually is nothing wrong with anybody who has any sort of illness.
But I don't want to create some hierarchy of like, because the people have been diminished now we need to elevate. It's like, I think, (Sarah: yeah, yeah) it's kind of like, people do have different approaches and, and, I don't want to... yeah. The challenge for getting help with something is walking around like, there's something wrong with me and there shouldn't be versus "I've got some serious obstacles. And there are multiple approaches out there that I should avail myself of," when people come to me and they say, doctor, I really don't believe in medications. And I, the thought I have is, that's like a carpenter saying, I don't believe in screwdrivers.
Sarah Marshall ND: Yes (laughs)
Guy Matyal MD: Like, wanna build a darn house? You use the tools available, but I say to them, well, luckily it's not a faith-based endeavor. Your belief is not required (Sarah: no) here, (inaudible) required, but not your belief, but it's sort of funny. It's like, we talk about how this could be of use to you rather than coming in with some predetermined notions of what I'm willing or unwilling to do based on some really unthoughtout bias.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Or when, when people say something like, well, I only want to go they're coming to me, but then they say, I only want natural means. I'm like, well, syphilis is natural. Like be careful what you think of... natural is complicated!
Sarah Marshall ND: Cyanide is natural,
Guy Matyal MD: Cyanide is natural, leprosy, very natural. It's been around. It's been around. You know? So it's like, the other side of this, by the way, when I was saying it saved lives, I was thinking of there's this, Cause, I like to go back into the world of history. Cause we always think every, everybody in history thinks they're the smartest and the most advanced. If you literally go back through history, certainly for thousands of people like, oh, we are like the pinnacle of human civilization.
And then you go to look at like, uh, the pyramids, like they were, (Sarah: yeah! Yeah!) they absolutely were the pinnacle of civilization. Absolutely.
Sarah Marshall ND: We need to keep ourselves in check, cause we also, right now think we're at the pinnacle of civilization.
Guy Matyal MD: We always do.
Sarah Marshall ND: Uh-huh
Guy Matyal MD: No, no. Now we don't think that. See, the funny part is that we know that.
Sarah Marshall ND: We know it.
Guy Matyal MD: We are that.
Sarah Marshall ND: Correct. Yep.
Guy Matyal MD: But there used to be this thing called hysteria, right? There's this, there's this diagnosis. Hysteria that was women (Sarah: mhm) was particularly, women (Sarah: yeah) is called hysterical. And in the last 150-200 years, it's was such a pejorative, became such a pejorative way to, to demean and diminish and, and, dominate and sideline women.
Oh, you're, you're, you're hysterical, right? People really don't know is that there's a whole chapter in the history of that, where that diagnosis saved thousands of lives, (Sarah: hmm) because it, it, it was originally referred to kind of a vague syndrome that Hippocrates described hysterical comes from the Greek word hysteros, which means uterus or womb (Sarah: mhm, mhm) .
Anyway. It was like, there was whatever was going on with you. It was because your, your womb was wandering inside of your body. (Sarah: hmm) Right? And people were like, Oh, that's so ridiculous. But you have to understand until, until we discovered anesthesia, we basically had no idea what was going on inside your body, except after you died, we could like cut you open and look around.
Sarah Marshall ND: After the fact,
Guy Matyal MD: after the fact. But like the only when anesthesia... surgeons actually cut you open, look around, sew you back up. Like a.. so wandering uterus. And that was like, it was like, you were hysterical. And in the middle ages, women were, were had all of these, unusual, symptoms, expressions, right? They were then accused of being witches and they were killed by the thousands in Europe.
And there was this doctor named Sydenham and he, was really committed to seeing just what's going on, like looking at the world and seeing what's there. He's an empiricist he's like, I don't want to know what you're telling me to see. I want to see what's there. And he would look at these women and he goes, There's no witch here there's something else.
I know what this is. This is this thing that the Greeks called hysteria. (Sarah: mmm) And he went around and testified in trial after trial, after trial that no, no, this is not a witch. This is a medical condition. (Sarah: hmm) And these women's lives were saved because they were no longer witches. They were "hysterical." They were (inaudible) , right? So isn't that interesting? (Sarah: it's remarkable, yeah) Isn't that interesting? So, and then over time, aha, women are hysterical is, was used again as a tool by a patriarchal society to say women are historical as a pejorative, so it's (sarah: yeah) but for a time, no, no, this isn't magic, this is medicine. Which is a huge state change. (Sarah: yeah) This isn't magic. This is medicine. This is biology. This is something we can observe. Right? Who knows. Now we might call some of them. I give them a diagnosis of schizophrenia or bipolar illness, but without any treatment who knows, who knows, we don't know what was being observed. But back then it was like this guy very, very, very deliberately, staunchly, he was kind of a good English doctor and went around and was like, Nope, not magic! Medicine. And that saved lives. (Sarah: yeah) The diagnosis saved their life. They were going to be killed. And now they're not, which is remarkable. (Sarah: mhm) Right? It's like, absolutely. And then, and then the thing gets turned into one more.
Right? So it's this it's all... which keeps pointing to. It's all is inside of this common endeavor called language. Like can't make up a word on my own. If I decide a bird means what you call a dog, nobody's going to know that. So anyway, just, an interesting moment when a new diagnosis saves lives because it alters how people view people.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Right.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Like, I'll give you a really controversial one. Okay. This is like the ultimate other in our society (Sarah: mhm) beyond even like people who you can say, the mentally ill are the ultimate other cause it's okay to say to someone, Oh, they're just crazy. Anytime you can dismiss someone as their attributes, then they're, you're making them an other. Here's here's a, who knows if you'll keep this in the podcast or not? All right. But like the ultimate, truly ultimate other in our society are people who are pedophiles.
Right?
Sarah Marshall ND: Yep.
Guy Matyal MD: Like people are, and this is like, this is like mmm very (Sarah: yeah) challenging, (Sarah: yeah) very tough stuff. And we say that they're evil and they're bad. (Sarah: yeah) They're bad people, right. Or bad people. And it is the case that some people. The way they develop is, the way most people develop is when you're like 12, you're attracted to a 12-year-old of either the same or the opposite sex.
And as you get older, the people you're attracted to become or remain age appropriate. Like when you're 20, you're not attracted to the 12-year-old. You might... like that, right? (Sarah: yep) But there are certain people as they age, as they grow up the, that doesn't alter. And they're forever attracted to children of a certain age.
And that's what's so. That's what's so. Now most people who have that predilection, don't actually act on it, (Sarah: mhm) but they suffer tremendously. And some do, and they suffered tremendously and they make other people suffer tremendously. Right?\ But that is one where it's still okay to completely criminalize it.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And not say, huh, I wonder how healing would look like here. I don't know what the answer is. I actually have no position on this. I have no, but I'm interested in looking at what's so, (Sarah: mhm) rather than having to see what we're told to see that these people are evil. (Sarah: yeah) it's kinda like. Something gets co-opted or underdeveloped and they are trapped.
Sarah Marshall ND: And to further the controversy of it, (Guy: yeah) we can look back over time where that was the African American slave, where that was Jews, where that was... in those conversations. Now for the majority of. Probably my listeners, this space would say that's absurd. That was the most horrible, like we have the other side of it that it, but just like that same, we know we're the pinnacle of human development and achievement at this moment in history. (Guy: yeah)
And yet when that was the case at each moment in history. And like, there may be more for us to learn here (Sarah: yeah) and. How do we,
Guy Matyal MD: I can't believe....
Sarah Marshall ND: Yeah.
Guy Matyal MD: Sorry to interrupt. I can't believe it went here. I'm like, Oh my goodness. (Sarah laughs) PHEW!
Sarah Marshall ND: Fabulous. (Guy clears his throat) No, and I appreciate the courage of that because that's, that, that is... this project for me is about us... one of my hypotheses observations is that healing. I put it very simply as it's it's about things becoming whole. If it wasn't returning to wholeness and optimal functioning (Guy: yeah) being in their original, pure, fully functioning state, which we can start to define that in a lot, a lot, a lot of different ways, but that that's what healing is about. (Guy: yeah) And at the most basic physiology level, like when skin is cut and it heals, it returns itself back into an integrous state (Guy: yeah, yeah, yeah) of being skin and usually is stronger for it. Yeah. And so. What I've found. One of the things that's been congruent through my practice in my own life is that... (laughs) if I haven't challenged myself, found myself in an uncomfortable situation, dropped myself into the unknown, been dealing and up against, going, wait a minute... I've seen life in myself this way, all this time. And now I'm starting to wonder maybe I had it wrong, or maybe there's another way to look at it. If none of those things are happening, probably not healing. Something else might be going on, but like for me, what I've distinguished around healing and I've even had some guests say, I don't even like the word heal.
I look at it this way and it's like, I'm not even attached to that word. It just gives us a particular access point.
Guy Matyal MD: Yeah, I appreciate what you're saying. Right. Because in the context of the conversation, we're just having, in the context of addiction, in the context of, sexual preferences that are not appropriate. But you have them, right? (Sarah: mhm) There is, I think sometimes people think healing, it means restore yourself to some space of effortlessness.
Sarah Marshall ND: Hm. Hm (laughs)
Guy Matyal MD: I want to be healed. (Sarah: yeah) And if you really look... right? And "I want to be healed" is very much like a passive phenomenon. The way we talk about it.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Like people go to shrines or Holy sites and I just like got to show up and I will be healed. And then they show up and they're either have some experience or they don't, but that's not what I am. What I'm hearing you. That's not what healing is. It's kind of like healing demands work. It demands sacrifice. Like the wholeness that you're referring to of the body is very different than the wholeness of a human being. There are people who, for whom drinking alcohol is like the hunger that you and I have when we don't eat for a day.
People who, for whom drinking is like that. Like, I hunger for it, like a starving person (Sarah: yeah) and they have to figure out that I live with hunger. And that's when I'm whole, not when I indulge in hunger, because that's when I stopped being whole for myself as a human being. There are people who just, that's just how it is.
I mean, if you go to AA meetings, that's mostly what's underneath the conversations, right? Like I'm whole, because I surrender to that which runs me, rather than going after what it is I want in the moment, and that
Sarah Marshall ND: or that it's going to go anywhere, that it's going to disappear. And it won't be there (Guy: yeah) and that hunger will be satisfied in some other way. It's like, (Guy: yeah) no, it might just stay there.
Guy Matyal MD: Yeah. And it's funny. It's like, I it's, it gets really complicated because healing takes that kind of work. It takes the work to confront what's having you not be whole, what's continuing to upend the apple cart of that, which you say you want.
And then to own it. And then to wrestle with it and then to fail a lot and then to, (Sarah chuckles) like, cause people go, "Oh!" It's like, there's this great Simpsons episode where parents are talking about their kids to a psychiatrist. Who's very wild. And they're like, we've tried nothing and we're all out of ideas. (Both laugh)
There are people who come to me and they will talk about having anxiety or having very sad feelings or low mood, or having difficulty engaging with people in their life and certainly medication's on the table. But unless we're talking about how you're engaging with life in some way, then the medicines, they will diminish the intensity of the experience so that it's tolerable, (Sarah: mhm) but they won't fundamentally lead to an altered anything.
Sarah Marshall ND: Yeah.
Guy Matyal MD: I mean, again, I'm like, just to be really clear, I'm not talking about people with severe manifestations of, of mental distress. Like if someone has full-blown psychosis or a depression, that's so severe that they can't get out of bed or they're thinking of killing themselves, that's a different world.
Sarah Marshall ND: Right.
Guy Matyal MD: That's not what I'm referring to, but I am referring to people who are like, I do nothing all day and I feel bad and I don't know what to do. (Sarah: mhm) And I will ask them: who's in your life that you talk with? What do you talk about with them? Like how do you spend your days? Do you get out and see green or do you exercise? Like, how much are you drinking? Do you smoke? Whatever you're smoking, right? Tobacco products or marijuana stuff like, like what's going on? Like tell me about your life. And a life begins to emerge. Tell me about like what life was like when you were growing up a little bit. So it's like you get the wholeness of the human and I often give patients homework, go and do some stuff and we'll talk, come back and we'll figure it out and we'll talk. And some, and a lot of the times they're like, I think I'm good. I'm like, I'm going to do some stuff. And if I need you, I'll call you back. And
Sarah Marshall ND: yeah.
Guy Matyal MD: part of the healing is, the role that, the relationship that you were referring to, like as a role as a healer. I think one of the things that we want to do is elevate our healers because we get so scared when we stop feeling well. It's very scary because mostly you and I wake up and we don't think, can I count on my body today?
Sarah Marshall ND: Yeah.
Guy Matyal MD: Like we assume it will work the way it's always worked. the usual sore spots will be sore and everything else will be fine and like that. Right? Like that part of my back that always...
Sarah Marshall ND: does that quirky thing, but yes, but even that's pretty consistent and we have all our structures and systems to take care of it.
Guy Matyal MD: That's right.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Well, so, but when someone has some sort of disease or some new physical experience, like a symptom that is new, that is terrifying because part of the terror is I can't count on my body and part of the terror is, what does this mean for my future?
And so we want someone to take care of us and that's not, there's nothing wrong with that. I don't begrudge it, but it is something for us as healers to be responsible for, as you were saying, both the role and the pedestal.
Sarah Marshall ND: Yeah.
Guy Matyal MD: The other part of it is for me and I fall into this trap way more often than I don't by the way is like you look at all these medical shows that have been on TV in the past, or currently the patients are never the heroes and they're the ones going through what they're going through, right?
Sarah Marshall ND: Yeah.
Guy Matyal MD: But it's always, it's striking that the patients are never the center of the story. The patients come and go, right. It, listen, you have a certain drama. It takes place in a location with a stable cast of characters. So that's going to be like a hospital. They're doctors and nurses, et cetera, and all the other stuff, or it's like a clinic or it's like a firehouse, but the patients are never the heroes. And they're the ones actually going through something they're on the journey.
Sarah Marshall ND: Yeah.
Guy Matyal MD: You're their more like, you're not Frodo. You're Gandalf. Frodo has got to go and walk.
Sarah Marshall ND: He's the one. Yeah. And transform himself and deal with all of his demons (Guy: yeah) and face (Guy: yeah) it and listers on his feet and yeah.
Guy Matyal MD: Seriously! And carry that burden. It gets heavier and heavier and heavier. It's like, yeah. And you're there to kind of guide support. Advise for VR, like you were, you were saying earlier also like provide hope that things can get better when even when it looks bleak, but they're the ones going through it.
So, it's, it's like, that's kind of the humility I was talking about. (Sarah: mhm) Not like to be flip about it or at all. But it's like, you kind of have to hold both. And by the way, in my experience, anecdotally patients often don't like that.
Sarah Marshall ND: No. Yeah.
Guy Matyal MD: Cause they want you to fix them.
Sarah Marshall ND: Yeah. There's, there's a lot of self-responsibility in being the center of your own story and being the hero. Yeah.
Guy Matyal MD: That's right.
Sarah Marshall ND: Oh yeah.
Guy Matyal MD: That's right. That's right. That's right. That's right. Mostly I want to sit by the sidelines and watch, like, in the civil war, there are all these accounts or there would be battles happening during the revolutionary war. People will come and watch
Sarah Marshall ND: like spectators, yeah.
Guy Matyal MD: Like spectators, like it's kind of macabre, it actually changed later in the civil war as the armies got bigger and things became incredibly brutal. Once people figured out, holy cow, this is not your grandfather's revolutionary war, this is a meat grinder, (Sarah: yeah) but it's, but it's like, yeah, like we would rather be the spectator, even as we imagine ourselves the hero. (Sarah: mhm) And that's a human thing. All of us are like that (Sarah: oh yeah) like, listen, nobody's going to tuck me in at night, but I wish there was somebody to tuck me in (both laugh)
Sarah Marshall ND: My mom was actually just here for two weeks (Guy: was she?) and it was like the best ever, And I've, I've actually shared about this in other episodes of the summer, I got diagnosed with chronic fatigue syndrome. (Guy: uh-huh) Diagnosis, creating distinction in language, and I'm still (Guy: yeah) working out, what does that actually mean? In reality? (Guy: sure)
Like what's the actual thing that's happening. And it was really great to have my mom here (Guy: aww) and cook for me and (Guy: aww) tuck me in and do those things. (Guy: yes) And then she went home and (Guy: yes) here I am, but yeah.
Guy Matyal MD: Yeah, yeah. Well, that's, that's probably part of why it felt so good because if she was there all the time,
Sarah Marshall ND: Oh no, I'd have a different conversation about it
Guy Matyal MD: You'd have a different conversation about it.
Sarah Marshall ND: Even in the two weeks, and we laugh about it. We have a great relationship, but yeah,
Guy Matyal MD: No listen, everything, everything that's extraordinary. First, what we do is we make it wallpaper. (Sarah: mhm) That's just what human beings do.
Sarah Marshall ND: Yeah.
Guy Matyal MD: I've got a nephew who's about to turn one and God loves that little dude. Everything is infinitely exciting for him. Like everything. And every moment is infinitely exciting for him. Very few of us live that way,
Sarah Marshall ND: Nope.
Guy Matyal MD: Yeah.
Sarah Marshall ND: Yeah.
(smacking lips) Guy Matyal MD: I dunno. This is the humility that we're talking about. When you are confronted with the loss of confidence in your physical wellbeing, everything starts to get questioned. (Sarah: mhm) Because, and you're getting taken right back to when you're I was thinking about my nephew, like he's he's at the phase of development called mastering my body.
How do I walk? How do I control my bowel, my urine, like the basic stuff, (Sarah: mhm) and when we're really sick or when we're at the end of life, that stuff tends to fail.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And then it's like, who am I? Who will help me? How can I trust myself? Some people who've done the work... really have done the work--and I don't include myself in this category to be clear--to really discover for themselves that there is something where they are, that is independent of their body. (Sarah: mhm) Like my body can change, but I'm not going to be impacted. I was dealing with something with my foot today and I'm like, imagining this is one of these like, like doctors know too much, right? Like. It's going to be an infection. I'm going to lose my foot. Like
Sarah Marshall ND: oh yeah. oh yeah. It's so easy.
Guy Matyal MD: It's so easy. A few years... I'll share this with you for a few years.
Like maybe seven, eight years ago. I had like this arrhythmia, like I literally, like, I'm like sitting in my home. I used to live in Boston, sitting in my home in Cambridge actually. And I feel kind of funny, kind of feels kind of funny. And for some reason I take my pulse in my neck and it's irregular and I was like, Holy cow.
That's new. It's like a Saturday night, right. I called, I called my doctor answering service, the on-call doctor calls me up and says, well, what does it sound like? I'm like, it's irregular. And then they said, please tap it out on the phone. I'm like, you're kidding. I'm like, okay. So I do that. And the doctor says it doesn't sound too bad.
You can just wait until Monday and come into the office. And I hang up the phone and I think to myself, I am not going to sleep. Cause I will die in my sleep tonight. I'm just not going to sleep. I'm not going to sleep for like, no, and I'm sitting and I'm angsty. I'm like, what should I do? Should I go to the ER, should I not go to the ER, should I stay at home?
I call my dad who's also a physician and he's like, all he says to me, he's a very wise man, my father, he says: Guy, you're an excellent psychiatrist. Now go to the hospital. (both laugh)
It's benign. And I got treated and it was fine. It was, it was a whole adventure. (Sarah: yeah) It was a whole adventure. (Sarah: yeah) When a relatively young, healthy adult walks into an ER and says, I'm having an irregular heartbeat. You go to the front of the line.
Sarah Marshall ND: Yeah.
Guy Matyal MD: But I knew all, I knew most of the nurses, it was the hospital where I worked at the time.
It was a whole adventure, but like, I don't know, in that moment, I couldn't trust my body.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And I wanted someone to tell me what this is now. The funny part is you and I've just been spending, like, I don't know, an hour talking about the, like the linguistic nature of diagnosis. I assume you don't use scatological language on your podcast.
Sarah Marshall ND: Oh no, have at it and say whatever you want, feel free to speak here.
Guy Matyal MD: But like... fuck no we don't live that way. Because I want to know what this is. That's how we actually live in our day to day. Tell me what I've got. Right? That's what we say. Tell me what this is, (Sarah: yeah) how come cause if I know what this is, I can do something with it.
Unless it's one of these diagnoses when I, what this is, is what I am. (Sarah: mhm) Like this whole bit about linguistic, but, blah blah blah that's a good for you doctors. Tell me what this is. That's why talk this way to patients, because now what's walking into the consultation is a lot of worry, fear, hesitation. Like they're not interested in this conversation. It's not appropriate. What they wanna know...what this is. And mostly what they want to know is can this get better? Can you make sense of this? Have you seen this before? Right. Like, and that is the purveyance of hope. That is, I think, underneath all of this conversation around what it is to heal is to tell people that the, what you're feeling and experiencing now, isn't the way it's always going to be.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And even if what you're feeling and experiencing physically is not likely to change who you will be about it.
Sarah Marshall ND: Yeah,
Guy Matyal MD: can grow and develop such that, you can manage, it is a quote by John F. Kennedy, that where you said, do not pray for a lighter load, pray for a stronger back, (Sarah: mmm) so it's like, but all the, but underneath it all, they come, people come to us for hope. And they always have. (Sarah: yeah) They always have, there's this, There is this, wonderful character of the doctor?
I don't know if you've ever read the books or watch the TV show "Little House on the Prairie," (Sarah: yes!) the doctor (Sarah: yeah) in "Little House on the Prairie" (Sarah: yeah) you, if you ever watched the show and if you get a chance to watch it, right, like it takes place like one in the 1840s, something that, or 18, I can't remember if it's (Sarah: yeah I don't remember) before or after the civil war, but something in the mid 19th century. (Sarah: yeah)
And. He mostly does nothing. (Sarah laughs) Like in the world of what we now expect doctors to do.
Sarah Marshall ND: Right? Yeah.
Guy Matyal MD: We can talk about where that comes from, but doctors, we want to do stuff, and there's a whole history around him exploring what happens inside the body and surgery. And then once you, once penicillin comes out and you can start to cure infectious disease, you can do stuff.
And with technology and the merging. People think of medicine and science, kind of being one that's emerging that happened in late 19th century Germany, where you have these laboratory science meets medicine to enhance techniques, progress, et cetera. but that's pretty new. (Sarah: yeah) Nowaday before that, before like a hundred years ago, maybe a little bit more, but not much, doctors could tell you what you've got. And what's likely to happen. And what are the small things you can do to have it maybe be a little bit better and they can cut stuff off. Like mostly,
Sarah Marshall ND: yeah
Guy Matyal MD: mostly there are (Sarah: yeah) exceptions, right? Like, but mostly they could, that's what you did. And that was incredibly reassuring. (Sarah: mhm) Like, like me in the airplane, putting my hands on the belly of this man with whom I didn't share a spoken language, but we definitely communicated.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And that was, that was all he needed. So I think a lot of medical training now is fantastic, but one of the things that it's lacking is how do you be with, (Sarah: mhm) and how do you be with suffering and distress without needing to do anything?
Yeah.
And that's. that's a lot of what there's actually, there is a part of medicine where that still has significant life, Western medicine and traditional medicine, which is a psychiatry to some degree it's actually in some ways shrinking. And palliative medicine, actually the field of palliative care.
Sarah Marshall ND: Have you heard of it? Have any of the programs now? Of course, I got to think of specifically narrative medicine.
Guy Matyal MD: Absolutely.
Sarah Marshall ND: And so this was one, my mother's stumbled on the conference of narrative medicine, (Guy: yes absolutely) sent it to me. I read the page and went, Oh my gosh, that's a lot. I mean, I'm not formally trained in it, so (Guy: yeah) I can't say this really, but when I read it, I was like, that's a lot of what I do (Guy: yeah) because for sure, I have the component of being with a person in any state that they're in it's, it's, (Guy: yeah) it's been something I've had for a long time and also have done a lot of work to cultivate my capacities for that. (Guy: yeah, yeah, yeah)
And while, as a naturopath, I ask my patients to do a lot of things. (Guy: sure!) Like whole lifestyle changes, (Guy: sure) very complicated treatment plans, which we build a slowly over time. And eventually they're like, I can't believe I used to complain when you had me on just five vitamins. I'm like, I know you wish for those days, don't you? But. But much like, like I actually was looking at moving to the Netherlands and in the Netherlands, there is no profession of naturopathic medicine, and most of the remedies and the tools I work with are not available. (Guy: hmm)
And I was actually looking at the reality is: my practice really didn't have to change very much because the things that. one of my other favorite quotes is, is medicine is what we entertain the patient with while the body takes care of the rest. And (both chuckle) there's this like our need to do something, but so much, like I spend.
50 minutes to an hour or twice a month with each of my clients. Usually for the first year, it's a lot of conversation, a lot of communication. And in the first six months predominantly it's them just offgassing (Guy: mmm) being able to be in communication. (Guy: mmm) And there's a particular way that I listen in those conversations.
And this is what I discovered was showing up in the d-, the, Discipline of narrative medicine, that there is a way that doctors even, they did studies where even surgeons who would listen to their patient's story in a particular way and allow that story's validity and to actually empathetically get the patient's experience, they had statistical information that showed better surgical outcomes when that communication and that relationship was intact. (Guy: hmm!)
And you would think surgery is just technical, like they're good at what they do and the doing of it, but they actually have evidence that shows the relationship that gets generated with the surgeon through that kind of communication, altered patient outcomes.
Guy Matyal MD: Interesting.
Interesting. Yeah. I don't know very much about narrative medicine in the other than that it exists and it's it's. It's a wonderful, there are things that are academic and other things that are practical, (Sarah: mhm) and it's interesting to see where they interface. One of the things that I do know that it does is exactly you're saying it actually trains people to listen in a particular way. (Sarah: mhm) There's also looking in a particular way.
There are a couple of medical schools. I know Harvard does this. There are others that do it as well. Cornell might. At least they used to before COVID. Is they take medical students to look at arts. So they can actually see the art, rather than think they know what's already there. the thing that I would love to happen is for that to keep going, you see, it's kind of like we sent, we send the children to do that.
No pun intended. These are fully from the adults, (Sarah: right, but I, yes, the medical students, yep) but like, like the senior surgeons are not being told to go to the art museum and just look,
Sarah Marshall ND: yeah. And see what's there just literally what is there. Yeah.
Guy Matyal MD: It's part of the challenge. And it is a real (inaudible) . Part of the tension is people do come to us for what we know. Otherwise they could just go on the internet or talk to their friends. So you're expected to know stuff. (Sarah: uh-huh) And that is attention because we really are expect there is a body of knowledge to master. And then there is this particular human being in front of you.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Like this particular set of experiences, emotions, concerns, histories, hopes, fantasies, dreams, et cetera.
And there are certain people, and it's always a dance and you bring your knowledge to bear, but the dance is unique every time. (Sarah: mhm) Sometimes I dance, well, hopefully more often than I step on toes, (Sarah chuckles: yeah) it's like, and sometimes I make a really good guess. See, part of the challenge with working with in psychiatry is a lot of what we deal with are disorders where insight is impaired. (Sarah: mhm) Like, if you have a broken arm, you're not going to start lifting weights because you say, oh, I have a broken arm, but when there is something happening in the brain (Sarah: yeah) and the brain, isn't aware that there's something in the brain it's very difficult (Sarah: yeah) to... right? Very, very difficult for people to engage. Because if... it's literally, like I were to tell you that I think you're not well and need to take medicine right now. And you'd be like, no, you're nuts. And we're saying, no, you're nuts. And it's kind of like, then you're just in an argument, right? (Sarah chuckles: yeah) Or it's like the old story story of, this kingdom that was cursed by a witch where the well was poisoned and everyone who drank from it went mad except for the King, because he had his own water supply and the people were bereft, because their King was insane. Right? So it's kind of like who's then you get into this whole notion, but part of the work is in maintaining relationship when there's nothing else going on so that when something happens, you're there as a trusted human. I had, I used to have, I'll change the details a little bit, but I had a patient who really just believed that people were after him. (Sarah: mmm)
And I mean, like the consulate of Ecuador, and the consulate of Columbia, we're conspiring against him and putting, listening devices in his house. And, but if you were to meet him, he would talk like this.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Just like, just like this. Yeah. And there are certainly, there may be medications that help. He just, he was like, no, no, they really are doing this.
And he would bring you pictures and evidence. And there was no evidence for it. But like, but for a time, I even, there was even one time when I called the local police department. Yeah. Is this? Really? Because he's so credible looking. Yeah. I'm like, am I going, am I maybe there's right? No. There was no, but we made sure that he had housing and we made sure that he had food stamps and we made sure that he kept his medical appointments for like the usual checkups and screens.
Cause he was kind of older. And that was me being a doctor. It wasn't about quote unquote fixing his view of the world.
Sarah Marshall ND: Yeah.
Guy Matyal MD: Cause there was nothing wrong with it. As weird as that sounds, it's just, doesn't quite fit into anybody else's and leaves him lonely, detached, and even like this, like people being afraid of him.
So all we worked on, well, he didn't work on, I think he just came and talked. All I worked on was, having him come back. And we would talk about his good old days when he was functional. And he went to a very prestigious college and, and declined afterwards. And that was okay once every month or two he'd come in.
And as long as I saw him, because he didn't have a phone, you see it because phones were tapped. He didn't have an email because emails are hacked. And he only had a PO box that he would check once in a blue moon. And he wouldn't give me his home address until much later. (Sarah: mhm) So as long as he came in, like he's still alive (Sarah: uh-huh) and he left, I'd never knew if I would see him again.
Right. But like the relationship was the thing.
Sarah Marshall ND: Yeah.
Guy Matyal MD: And it was pleasant to see him, just pleasant. And this is rather than the myth of perfectability, (Sarah: mhm) it was a myth of like having to have like the body of someone who's on men's health or maximum or something like that. (Sarah: mhm) And that's what like, and if I don't look like that, there must be something wrong.
Like if I, the way I have to think, just like everybody thinks, like the myth of having the perfect mind, like
Sarah Marshall ND: yeah.
Guy Matyal MD: Versus I don't know, how do I engage in the world where I get to grow and be whole as me, not a whole, as some other person's vision of me. So it gets in; it's tension. Cause like on the other hand, you don't, you don't want people like...walking around naked in the middle of winter,
Sarah Marshall ND: right? Yeah.
Guy Matyal MD: But there is something around just like, especially in psychiatry, one of the things that we do well, when we do it well, is bringing empathy to that part of humanity that people don't want to look and see. One of my mentors used to say, our job is to find everyone's story of epic heroism.
Whatever it is. You gotta find it. It's not like, is it it's there somewhere. (Sarah: yeah) You go to find it.
Sarah Marshall ND: Not...not "do they have it?" It's your job to find it.
Guy Matyal MD: It's there. Go find it. (claps) Go look for it.
Sarah Marshall ND: Yeah. Beautiful. I think that's a good place to put a pin in it for now.
Guy Matyal MD: Alright.
Sarah Marshall ND: I love it.
Guy Matyal MD: Perfect.
Sarah Marshall ND: I so appreciate it. This has been a really extraordinary wandering about the hallways.
Guy Matyal MD: It has.
Sarah Marshall ND: It's been really awesome.
Guy Matyal MD: Thank you.
Sarah Marshall ND: And I appreciate you so much and uh yeah,
Guy Matyal MD: Right back atcha, thank you for the opportunity to speak and be heard. And. Yeah, I hope I fulfilled on your intentions.
Sarah Marshall ND: Fully.
Guy Matyal MD: Alright great.
Sarah Marshall ND: All of it. It's fantastic.
Guy Matyal MD: So great to be with you.
Sarah Marshall ND: Yeah. I even had one of those moments where I was like, I didn't know that. Now I'm looking at it newly. It's fantastic.
Guy Matyal MD: Okay. Great!
Sarah Marshall ND: Yup. Fulfilled that one too. (inaudible)
Guy Matyal MD: Fulfilled that one too. (Sarah laughs) Excellent, excellent.
Sarah Marshall ND: Awesome. (siren in the background) Well, I very much appreciate you and maybe we'll get to do this again sometime.
Guy Matyal MD: I hope so. Take care.
Sarah Marshall ND: Alright bye.
Guy Matyal MD: Bye.
Sarah Marshall ND: Thank you to today's guest. Dr. Guy Maytal for his humble wisdom and kind heart. If HEAL has been making a difference for you, we would greatly appreciate it if you left us a review on your favorite platform so we can reach more people and help heal our world. For a full transcript and all the resources for today's show visit SarahMarshallND.com/podcast. Keep the conversation going, have ideas or a healing story to share? Send us your thoughts, wants for future episodes, or questions by contacting us at SarahMarshallND.com or on Instagram at @SarahMarshallND. Special thanks to our music composer, Roddy Nikpour, and as always, our editor, Kendra Vicken. We'll see you next time.